Palliative Care And End
Nizar Bhulani1, Arjun Gupta2, Ang Gao1,3, Jenny Li2, Chad Guenther2, Chul Ahn1,3, Elizabeth Paulk2, Stephanie Houck2, Muhammad S. Beg1,2
1Harold Simmons Comprehensive Cancer Center, UT Southwestern Medical Center , USA
Contributions: Conception and design: N Bhulani, MS Beg Administrative support: MS Beg Provision of study materials or patients: N Bhulani, MS Beg Collection and assembly of data: N Bhulani, A Gao, C Ahn, MS Beg Data analysis and interpretation: A Gupta, A Gao, J Li, C Guenther, C Ahn, E Paulk, S Houck Manuscript writing: All authors Final approval of manuscript: All authors.
Correspondence to:
Background: Palliative care has been associated with improved survival and quality of life, with lower rate of end-of-life health care utilization and cost. We examined trends in palliative care utilization in older pancreatic cancer patients.
Methods: Pancreatic cancer patients with and without palliative care consults were identified using the Surveillance, Epidemiology, and End Results -Medicare linked database between 2000 and 2009. Trend of palliative care use was studied. Emergency room/intensive care unit utilization and costs in the last 30 days of life were compared between both groups using propensity score-matched analysis.
Keywords: Palliative care end-of-life intensive care unit emergency room cost of care pancreatic cancer
Submitted Jan 24, 2018. Accepted for publication Mar 01, 2018.
doi: 10.21037/jgo.2018.03.08
You Can’t Get Through A Normal Conversation Or Keep Track Of Dates And Times
Dr. Hascalovici states, “You might cover it up or figure out ways to excuse yourself from conversations that “take a turn,” but if you find yourself regularly fumbling to converse, forgetting common words and phrases, being unable to maintain concentration on a dialogue, or feeling awkward or “lost” within a conversation, it could be sign of dementia.”
Dr. Mitchell adds, “Dementia is a common degenerative disease that typically affects older adults. Early symptoms of dementia can be subtle and may not be immediately apparent to family and friends. However, some warning signs can indicate the early onset of dementia. One of the most common early signs is difficulty tracking time and dates. This can manifest in forgetting the day or the inability to keep track of appointments. Another early sign of dementia is trouble keeping track of conversations. This may involve forgetting what was just said or jumping from topic to topic without any apparent connection. If you notice these or other changes in a loved one’s behavior, you must see a doctor for an evaluation. Early diagnosis and treatment can help to slow the progression of dementia.”
Diabetes And Pancreatic Cancer
While less common, developing diabetes may be a sign of pancreatic cancer, especially in patients who are older and have diabetes come on suddenly.
Sometimes, pancreatic cancer may damage the cells in your pancreas that help produce insulin , leading to high blood sugar and diabetes.
The cancer may not always alter blood sugar levels enough to show signs of diabetes, but if it does, symptoms may include increased thirst, hunger and urination.
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How Can I Prevent Pancreatic Cancer
We dont know what actually causes pancreatic cancer, so its difficult to know how to prevent it. However, you can change your day-to-day behaviors to become healthier. These tips may help reduce the risk of getting pancreatic cancer:
- Dont smoke. If you do smoke or use tobacco in any form, try to quit.
- Try to reach and maintain a normal weight by eating healthy and exercising.
- Drink alcohol in moderation, or quit drinking altogether.
- Try to avoid getting diabetes. If you have it, control your blood sugar levels.
- Use safety equipment if your work exposes you to toxins.
What Is A 5
A relative survival rate compares people with the same type and stage of pancreatic cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of pancreatic cancer is 50%, it means that people who have that cancer are, on average, about 50% as likely as people who dont have that cancer to live for at least 5 years after being diagnosed.
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Pancreatic Cancer In The Older Patient
Michael J. OConnell, MDOncology
Pancreatic cancer is a disease seen predominantly in elderly patients. Compared to younger patients, older patients are more likely to present with early-stage disease and, therefore, may be candidates for aggressive local
ABSTRACT: Pancreatic cancer is a disease seen predominantly in elderly patients. Compared to younger patients, older patients are more likely to present with early-stage disease and, therefore, may be candidates for aggressive local treatment. Little published information exists on treatment outcomes for elderly patients with potentially resectable disease or those with locally advanced or metastatic pancreatic cancer. The limited information available suggests that elderly patients are as likely to benefit from surgery, radiation, and chemotherapy as younger patients. Despite this apparent benefit, elderly patients appear to have a worse long-term outcome. This may be due to the failure to offer them aggressive treatment or to comorbid conditions. Nevertheless, further studies need to be conducted in this area, and greater emphasis needs to be placed on including elderly patients in clinical trials. For elderly patients with terminal disease, there should be better use of palliative measures that may be of benefit. Each of these issues is discussed in detail.
General Information About Pancreatic Cancer
In This Section
Estimated new cases and deaths from pancreatic cancer in the United States in 2022:
- New cases: 62,210.
- Deaths: 49,830.
The incidence of carcinoma of the pancreas has markedly increased over the past several decades and ranks as the fourth leading cause of cancer death in the United States. Despite the high mortality rate associated with pancreaticcancer, its etiology is poorly understood.
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Can Elderly Patients With Pancreatic Cancer Gain Survival Advantages Through More Radical Surgeries A Seer
- 1Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- 2Department of Hepatobiliary Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
- 3Department of Clinical Medicine, Southwest Medical University, Luzhou, China
Background and Aims: In recent years, the best treatment method for pancreatic cancer in elderly patients has remained controversial. Surgery is the main treatment modality for pancreatic cancer. This study aimed to determine whether elderly patients with pancreatic cancer can gain survival advantages through more active and radical surgical treatment and evaluate the best treatment method and potential prognostic factors.
Methods: From the Surveillance, Epidemiology, and End Results program database, 10,557 elderly patients with pancreatic cancer were included as Cohort 1, and Propensity Score Matching evaluation was performed to generate Cohort 2 . Overall Survival and Cause-Specific Survival were determined using KaplanMeier survival curves, and differences were assessed using the Log-rank test. Multivariate logistic regression analysis and the forest plot of hazard ratio was made to assess the association between potential prognostic factors, including surgery and different surgical methods, and survival in elderly patients.
Symptoms If Cancer Has Spread To The Bone
You might have any of the following symptoms if your cancer has spread to the bones:
- pain from breakdown of the bone the pain is continuous and people often describe it as gnawing
- backache, which gets worse despite resting
- weaker bones they can break more easily
- raised blood calcium , which can cause dehydration, confusion, sickness, tummy pain and constipation
- low levels of blood cells blood cells are made in the bone marrow and can be crowded out by the cancer cells, causing anaemia, increased risk of infection, bruising and bleeding
Cancer in the spinal bones can cause pressure on the spinal cord. If it isn’t treated, it can lead to weakness in your legs, numbness, paralysis and loss of bladder and bowel control . This is called spinal cord compression. It is an emergency so if you have these symptoms, you need to contact your cancer specialist straight away or go to the accident and emergency department.
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How Is Pancreatitis Treated In The Elderly
The patient with acute pancreatitis shows a strict bed rest, fasting for 3-5 days, an ice pack on the stomach. In the days of fasting, intravenously drip an isotonic solution of sodium chloride with glucose to combat intoxication and dehydration of the body. With increased gastric secretion, it is possible to use histamine H2-receptor blockers. Novocain solutions , no-spines , promedol with isotonic sodium chloride solution are intravenously dripped intravenously, increasing the analgesic effect with antihistamines. Treatment with antifermental drugs in geriatric patients is rare, because of the absence of a clinic and pronounced enzyme and a high risk of allergic reactions. The use of aminocine and gelatin is shown as a means of reducing the activity of pancreatic enzymes.
To combat shock intravenously drip 1,5-2 liters of a 5% glucose solution, use glucocorticosteroids. To prevent the development of secondary infection, antibiotics are prescribed.
At the expressed painful attack at persons of elderly and senile age the full fasting within 24 hours is recommended. Hungry days are held to limit gastric secretion and exocrine function of the pancreas. In the first day you can consume up to 800 ml of liquid in the form of drinking, preferably Borjom and broth of rose hips . On the 2-5th day – steam protein omelets, mashed potatoes, oat mucous soup, mushroom soup, mashed meats, meat soufflé. A day in total up to 1000 calories.
- pancreatic enzymes
Treatment Of Locally Advanced Pancreatic Cancer
In This Section
| .017 |
Evidence :
Three trials evaluated combined modality therapy versus radiation therapy alone. The trials had substantial deficiencies in design or analysis. Initially, the standard of practice was to give chemoradiation therapy based on data from the first two studies however, with the publication of the third study, standard practice has changed to chemotherapy followed by chemoradiation in the absence of metastases.
Surgery
Palliative surgery
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Potentially Curable If Caught Very Early
Despite the overall poor prognosis and the fact that the disease is mostly incurable, pancreatic cancer has the potential to be curable if caught very early. Up to 10 percent of patients who receive an early diagnosis become disease-free after treatment. For patients who are diagnosed before the tumor grows much or spreads, the average pancreatic cancer survival time is 3 to 3.5 years.
Pancreatic Cancer And Its Symptoms
Pancreatic cancer often has a high mortality rate because its seldom detected at its early stages when its most curable. Many of the symptoms it causes dont become noticeable until after cancer has spread to other organs so if you have a family history of pancreatic cancer, its important for your family and your parents elder care providers to know the symptoms and not ignore anything that might be a sign of pancreatic cancer.
The pancreas is an organ that is located behind the lower part of the stomach. About the size of a hand, the pancreas makes pancreatic juices called enzymes. The enzymes break down sugars, fats, and starches. The pancreas also assists the digestive system by making hormones that are chemical messengers that travel through the blood. Pancreatic hormones help regulate blood sugar levels and appetite, stimulate stomach acids, and tell the stomach when to empty.
Both cancerous and non-cancerous tumors can occur in the pancreas. The most common type of cancer that forms in the pancreas starts in the cells that line the ducts that carry digestive enzymes out of the pancreas.
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Characteristics Of Pancreatic Cancer In The Elderly
TABLE 1
Disease-Specific 5-Year Survival of 44,438 Patients With Pancreatic Adenocarcinoma, 1985-1990
Several studies have shown that older patients are less likely to be staged than younger patients. Among those who are staged, it appears that older patients present with earlier-stage disease. Despite this fact, older patients have a worse overall 5-year survival compared to younger patients . This may be due to less aggressive treatment of elderly patients, as well as deaths due to comorbid conditions. However, no studies are available that adequately address this issue.
Kamisawa et al examined the pathologic features of pancreatic cancer in 89 elderly patients and compared them to 184 younger patients. With advancing age, proportionally more women were diagnosed. There were no differences in the grade or location of tumors in younger vs older patients, and there was no difference in the incidence of local spread. Elderly patients, however, did have fewer hematogenous metastases than younger patients.
In another study, it appeared that older patients had more diploid tumors, and younger patients had more aneuploid tumors .
What Are The Screening Recommendations For Pancreatic Cancer
There are currently no standard screening recommendations for pancreatic cancer. Several types of cancer, such as breast, colon, and lung cancer, have screenings available, but no routine screening exists for pancreatic cancer.
There are a few blood tests you can take if youre at high risk of pancreatic cancer, including the GRAIL Galleri test and the Immunovia Inc. IMMray PanCan-d test.
But these tests arent approved by the Food and Drug Administration or covered by any insurance plan. Youll also need a doctors order to take to them.
If youre concerned about your risk of pancreatic cancer, ask a doctor for recommendations.
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As Cancer Continues To Grow And Progress Some Of The Symptoms Listed Above Can Cause Some Serious Complications Such As:
Weight loss Weight loss might happen as cancer consumes the bodys energy. Nausea and vomiting caused by a tumor pressing on the stomach may make it difficult to eat. Your parents body might begin to struggle with processing nutrients from food because the pancreas isnt making enough digestive juices.
Jaundice When pancreatic cancer causes the livers bile duct to get blocked, it can lead to jaundice. Jaundice symptoms include yellow skin and eyes, dark-colored urine, and pale-colored stools.
Pain A tumor pressing on nerves in your abdomen can cause severe pain.Bowel obstruction Pancreatic cancer that grows into the first part of the small intestine can block the flow of digested food from your stomach into your intestines.
If pancreatic cancer is diagnosed, having a team of elder care providers to help your parent as he goes through treatment will benefit both him and yourself.
Loss Of Appetite And/or Weight Loss
Dr. Mitchell shares, “In clinical practice, loss of weight or loss of appetite is a concerning symptom or ‘red flag.’ Most of us would agree that it is typically easier to gain weight than lose weighthence the billion-dollar weight loss industry. In my mind, weight loss in seniors is cancer until proven otherwise. Cancer needs the energy to growit will steal the power you need to get going and have that bounce in your step. Cancer’s need for energy contributes to why a senior with pancreatic cancer might have weight loss. At all stages of life, we must make conscious efforts to eat a balanced diet. For example, some seniors are known to have the ‘tea and toast’ diet, which might lead to nutritional deficiencies in the body, resulting in weight loss and fatigue. When you give your body the right fuel at the right time, it will be easier to detect subtle body changes that might indicate cancer.”
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Prognosis Depends On Stage At Diagnosis
Long-term prognosis for pancreatic cancer depends on the size and type of the tumor, lymph node involvement and degree of metastasis at the time of diagnosis. The earlier pancreatic cancer is diagnosed and treated, the better the prognosis.
Unfortunately, pancreatic cancer usually shows little or no symptoms until it has advanced and spread. Therefore, most cases are diagnosed at later, more difficult-to-treat stages.
Read more about pancreatic cancer staging.
Physical Status After Treatment
Getting the right nutrition and keeping physically active as much as possible under the circumstances can really impact how a patient tolerates the side effects of treatment and the symptoms of pancreatic cancer.
Younger patients tend to do better because they have fewer other conditions that may limit recovery, but even older patients can positively impact their prognosis by focusing on nutrition and exercise.
Talk to your doctor about what to expect after treatment and what you can do to get the best possible prognosis.
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You Were Recently Diagnosed With Diabetes Or Your Well
Research suggests that a sudden onset of type 2 diabetes in people age 50 or older may be an early symptom of pancreatic cancer, especially in those who have a low body mass index, experience continuous weight loss or do not have a family history of diabetes.
A sudden change in blood sugar levels in diabetics who previously had well-controlled diabetes may also be a sign of pancreatic cancer. Learn more about diabetes and pancreatic cancer.
Review the infographic for a closer look at pancreatic cancer symptoms and risk factors.
